Placement

Please fill out this form to submit information about yourself and your dog. This information will help us get a better understanding about your dog for possible placement help. All fields marked with an * are required. We will get back to you as soon as possible. Please send any photos of the dog to forms@aussierescuesocal.com and include dogs name and your name in the title.

We will contact you as soon as possible after processing the form. Please note: fields marked with an (*) are required.

Name *

First

Last

Street *

City *

State *

Zip code *

Phone number *

Is this a: *

Home phone
Cell phone

Work Phone

Email *

Preferred method of contact and best time of day to reach you (Morning/Afternoon/Night)

Are you the legal owner of the dog? *

Name of dog needing placement assistance

Is this dog a:

Male
Female

Dog's age

Dog's weight

Other:

How long have you had the dog?

Does the dog have a microchip?

Microchip number

Why are you seeking placement for the dog?

Is there a time frame for rehoming your dog? (for example - few days, few weeks, by a specific date, none just would like to find it a new home)

How many times do you feed the dog per day?

What type of food?

Can you provide some of their food if placed?

Has this dog ever shown aggression toward people or other animals including but not limited to an injury bite? (one that left bruised or broken skin)

Were Animal Control or the Police involved?

Did the bite require medical attention?

If yes to any of the above, please explain in detail

Other:

If from a Shelter/Rescue Organization/Breeder please complete information below: Shelter/Rescue Organization/Breeder Name

First

Last

Shelter/Rescue Organization/Breeder Address

Shelter/Rescue Organization/Breeder City

Shelter/Rescue Organization/Breeder State

Shelter/Rescue Organization/Breeder Zip

Shelter/Rescue Organization/Breeder Phone

If there was a Shelter/Rescue Organization/Breeder, have you reached out to them to return your dog? Most adoption contracts contain verbiage that requires you to return the dog to them in the event that you can no longer keep the dog.

If no, Please explain why in detail:

Other:

How does this dog do on a leash?

Walks on a loose leash
Pulls lightly
Pulls Hard
Dont know

Is this dog housebroken?

Yes
Partially
No
Don't know

Is this dog crate trained?

Yes, likes the crate
Partially, anxious but settles down eventually
No, barks or tries to get out
Don't know

If the dog is left loose indoors, how is it?

Well Behaved, no problems
Destructive

Describe what you feel is the best type of home for the dog

Please run through, in detail, a typical day for this dog (where it spends it's time, play/exercise routines, etc.)

Does the dog have any bad habits we should know?

What are the dog's favorite activities?

What else can you tell us about the dog?

Veterinarian Clinic Name

Veterinarian Clinic Phone Number

When did this dog last see a veterinarian, if known?

Is your Aussie Spayed/Neutered?

Yes
No
Not sure

If no or not sure, explain why

Is the dog current on vaccinations?

If no, explain why

Provide month and year of the last rabies vaccination

Provide month and year of last DHLPP

Is your Aussie currently being given HW preventative on a monthly basis?

Provide month and year of the last time HW preventative was given

Provide month and year of the last HW test was conducted by your veterinarian

What were the results of the last Heartworm test conducted by your veterinarian?

Positive
Negative

Describe any known injurys or known health issues

Is dog current on any medications excluding heartworm and flea/tick preventative? Please list:

I certify that all of the above information is accurate I understand that by filling out this application, I am under no obligation to surrender a dog from ARSC *

Phone